开腹胆肠吻合与开腹胆道支架置入治疗恶性梗阻性黄疸的疗效观察

目的：探讨开腹胆肠吻合及开腹胆道支架置入在恶性梗阻性黄疸患者临床治疗中的应用价值及选择。方法：回顾分析71例不能根治切除的恶性梗阻性黄疸患者采用开腹胆肠吻合（n=44）及开腹置入记忆金属合金胆道内撑支架（n=27）治疗的情况。结果：所有患者均完成胆肠吻合或胆管末端支架置入达到内引流。术后胆红素均在术后第1周下降约100μmol/L;谷草转氨酶、谷丙转氨酶、碱性磷酸酶在术后第2周以后开始较术前明显下降（P〈0.05）。全组中位生存时间为22周,平均生存（31.69±33.24）周。全组死亡4例,死亡率5.63%。主要并发症有胆管炎12例,胆道出血5例,肝功能衰竭3例,多器官功能衰竭3例。结论：开腹胆肠吻合及开腹胆道支架置入均可有效解除恶性梗阻性黄疸患者胆道梗阻,改善肝功能;临床应根据患者的局部及全身情况选择不同的手术方式,提高安全及有效性,尽可能减少并发症的发生。

Effect Observation of Biliary Stent Insertion Through Operation and Cholangiojejunostomy in Treatment of Malignant Biliary Obstruction

Objective：To discuss the different value between biliary stent insertion through operation and Cholangiojejunostomy in treatment of malignant biliary obstruction.Methods：Seventy-one cases of malignant biliary obstruction through the treatment of biliary stent insertion（n=27） and Cholangiojejunostomy（n=44） were reviewed retrospectively.Results：All the patients of Malignant biliary obstruction were successfully done through Cholangiojejunostomy or Biliary stent insertion and achieved internal biliary drainage.Compared with the level of the bilirubin before operation,it decreased about 100 μmol/L one week after the stent insertion or Cholangiojejunostomy in all patient s.Compared with the levels of glutamic oxalacetic transaminase,glutamic pyruvict ransaminase and alkaline phosphatase before operation,they decreased sharply 2 week after the stent insertion or Cholangiojejunostomy（P0.05）.The median survival time was 22 weeks.The average survival time was（31.69±33.24）weeks.Four patients died in hospital after opertation,and the mortality was 5.63%.Complications included 12 cases of cholangitis,5 cases of bile duct hemorrhage,3 cases of hepatic failure and 3 cases of multiple organ failure.Conclusions：The way of The bile duct stent insertions through operation and Cholangiojejunostomy are all effective in relieving the bile duct construction with malignant biliary obst ruction..Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency,and to decrease the occurrence of complications.